Diabetic ketoacidosis

Definition

Diabetic ketoacidosis is a serious complication of diabetes that occurs when your body produces high levels of blood acids called ketones.

The condition develops when your body can't produce enough insulin. Insulin normally plays a key role in helping sugar (glucose) — a major source of energy for your muscles and other tissues — enter your cells. Without enough insulin, your body begins to break down fat as fuel. This process produces a buildup of acids in the bloodstream called ketones, eventually leading to diabetic ketoacidosis if untreated.

If you have diabetes or you're at risk of diabetes, learn the warning signs of diabetic ketoacidosis — and know when to seek emergency care.

Symptoms

Diabetic ketoacidosis signs and symptoms often develop quickly, sometimes within 24 hours. For some, these signs and symptoms may be the first indication of having diabetes. You may notice:

Excessive thirst

Frequent urination

Nausea and vomiting

Abdominal pain

Weakness or fatigue

Shortness of breath

Fruity-scented breath

Confusion

More-specific signs of diabetic ketoacidosis — which can be detected through home blood and urine testing kits — include:

High blood sugar level (hyperglycemia)

High ketone levels in your urine

When to see a doctor

If you feel ill or stressed or you've had a recent illness or injury, check your blood sugar level often. You might also try an over-the-counter urine ketones testing kit.

Contact your doctor immediately if:

You're vomiting and unable to tolerate food or liquid

Your blood sugar level is higher than your target range and doesn't respond to home treatment

Causes

Sugar is a main source of energy for the cells that make up your muscles and other tissues. Normally, insulin helps sugar enter your cells.

Without enough insulin, your body can't use sugar properly for energy. This prompts the release of hormones that break down fat as fuel, which produces acids known as ketones. Excess ketones build up in the blood and eventually "spill over" into the urine.

Diabetic ketoacidosis is usually triggered by:

An illness. An infection or other illness can cause your body to produce higher levels of certain hormones, such as adrenaline or cortisol. Unfortunately, these hormones counter the effect of insulin — sometimes triggering an episode of diabetic ketoacidosis. Pneumonia and urinary tract infections are common culprits.

Risk factors

Uncommonly, diabetic ketoacidosis can occur if you have type 2 diabetes. In some cases, diabetic ketoacidosis may be the first sign that a person has diabetes.

Complications

Diabetic ketoacidosis is treated with fluids, electrolytes — such as sodium, potassium and chloride — and insulin. Perhaps surprisingly, the most common complications of diabetic ketoacidosis are related to this lifesaving treatment.

Low potassium (hypokalemia). The fluids and insulin used to treat diabetic ketoacidosis can cause your potassium level to drop too low. A low potassium level can impair the activities of your heart, muscles and nerves.

Swelling in the brain (cerebral edema). Adjusting your blood sugar level too quickly can produce swelling in your brain. This complication appears to be more common in children, especially those with newly diagnosed diabetes.

Left untreated, the risks are much greater. Diabetic ketoacidosis can lead to loss of consciousness and, eventually, it can be fatal.

A medical provider who sees you for possible diabetic ketoacidosis will need answers to these questions as quickly as possible:

What are your signs and symptoms?

When did these signs and symptoms develop? Are they getting worse?

Have you been diagnosed with diabetes?

Have you recently checked your blood sugar level?

Have you recently checked your ketone level?

Have you lost your appetite?

Can you keep fluids down?

Are you having trouble breathing?

Do you have chest pain?

Have you had a recent illness or infection?

Have you had recent stress or trauma?

Have you recently used alcohol or recreational drugs?

How closely have you been following your diabetes treatment plan?

How well would you say your diabetes has been managed just before these symptoms?

Tests and diagnosis

If your doctor suspects diabetic ketoacidosis, he or she will do a physical exam and various blood tests. In some cases, additional tests may be needed to help determine what triggered the diabetic ketoacidosis.

Blood tests

Blood tests used in the diagnosis of diabetic ketoacidosis will measure:

Ketone level. When your body breaks down fat and protein for energy, acids known as ketones enter your bloodstream.

Blood acidity. If you have excess ketones in your blood, your blood will become acidic (acidosis). This can alter the normal function of organs throughout your body.

Additional tests

Your doctor may order tests to identify underlying health problems that might have contributed to diabetic ketoacidosis and to check for complications. Tests might include:

Blood electrolyte tests

Urinalysis

Chest X-ray

A recording of the electrical activity of the heart (electrocardiogram)

Treatments and drugs

If you're diagnosed with diabetic ketoacidosis, you might be treated in the emergency room or admitted to the hospital. Treatment usually involves:

Fluid replacement. You'll receive fluids — either by mouth or through a vein (intravenously) — until you're rehydrated. The fluids will replace those you've lost through excessive urination, as well as help dilute the excess sugar in your blood.

Electrolyte replacement. Electrolytes are minerals in your blood that carry an electric charge, such as sodium, potassium and chloride. The absence of insulin can lower the level of several electrolytes in your blood. You'll receive electrolytes through a vein to help keep your heart, muscles and nerve cells functioning normally.

Insulin therapy. Insulin reverses the processes that cause diabetic ketoacidosis. In addition to fluids and electrolytes, you'll receive insulin therapy — usually through a vein. When your blood sugar level falls below 240 mg/dL (13.3 mmol/L) and your blood is no longer acidic, you may be able to stop intravenous insulin therapy and resume your normal insulin therapy.

As your body chemistry returns to normal, your doctor will consider additional testing to check for possible triggers for the diabetic ketoacidosis. Depending on circumstances, you might need additional treatment.

For example, for previously undiagnosed diabetes, your doctor will help you create a diabetes treatment plan. For a bacterial infection, he or she might prescribe antibiotics. If a heart attack seems possible, your doctor might recommend further evaluation of your heart.

Prevention

There's much you can do to prevent diabetic ketoacidosis and other diabetes complications.

Commit to managing your diabetes. Make healthy eating and physical activity part of your daily routine. Take oral diabetes medications or insulin as directed.

Monitor your blood sugar level. You might need to check and record your blood sugar level at least three to four times a day — more often if you're ill or under stress. Careful monitoring is the only way to make sure your blood sugar level remains within your target range.

Check your ketone level. When you're ill or under stress, test your urine for excess ketones with an over-the-counter urine ketones test kit. If your ketone level is moderate or high, contact your doctor right away or seek emergency care. If you have low levels of ketones, you may need to take more insulin.

Be prepared to act quickly. If you suspect that you have diabetic ketoacidosis — your blood sugar level is high, and you have excess ketones in your urine — seek emergency care.

Diabetes complications are scary. But don't let fear keep you from taking good care of yourself. Follow your diabetes treatment plan carefully, and ask your diabetes treatment team for help when you need it.